经皮单切口椎间孔镜治疗双节段椎间盘突出症的临床经验

Experience of Percutaneous Transforaminal Endoscopic Lumbar Discectomy in the Treatment of Double-level Disc Herniation with A Single Incision

目的探讨经皮单切口椎间孔镜治疗双节段椎间盘突出症的疗效。方法回顾性分析2015年1月至2018年1月深圳市第七人民医院骨科采用经皮椎间孔镜单切口双节段髓核摘除术治疗的22例腰椎间盘突出症的临床资料。其中男13例,女9例;年龄47~71岁,平均61.5岁。术前均行MRI检查明确椎间盘突出程度。根据髓核摘除节段:L4/L5及L5/S111例,L3/L4及L4/L57例,L2/L3及L3/L42例,L1/L2及L2/L32例。通过VAS、ODI评分及Macnab评分标准评价手术疗效。结果所有伤口一期愈合。所有患者均获得随访,随访时间6~36个月,平均18.5个月。无永久性神经根损伤、大血管损伤和硬脊膜囊撕裂等并发症。1例术后复发行开放髓核摘除手术。术后VAS评分及ODI评分较术前明显降低;末次随访时Macnab评分:优17例,良4例,可1例,优良率95.5%。结论单切口经皮椎间孔镜治疗双节段腰椎间盘突出症疗效满意。

Objective To investigate the curative effect of percutaneous transforaminal endoscopic lumbar discectomy with a single incision in the treatment of double segments of disc herniation.Methods Clinical data of 22 cases of lumbar intervertebral disc herniation treated by percutaneous transforaminal endoscopic lumbar discectomy with a single incision and double segmental nucleus pulposus discectomy were retrospectively analyzed from January 2015 to January 2018 in the Department of Orthopaedics,Shenzhen Seventh People's Hospital.There were 13 males and 9 females,whom aged from 47 to 71 years,with an average of 61.5 years.Preoperative MRI examination was performed to determine the degree of disc herniation.According to the segment of nucleus pulposus excision,there were 11 cases of L4/L5 and L5/S1,7 cases of L3/L4 and L4/L5,2 cases of L2/L3 and L3/L4,and 2 cases of L1/L2 and L2/L3.The efficacy was evaluated by VAS,ODI and Macnab criteria.Results In the 22 patients,their wounds all healed inⅠstage.All patients were followed up for 6~36 months,with an average of 18.5 months.There was no permanent nerve root injury,blood vessel injury or dural sac tear.One patient underwent open nucleus pulposus resection because of the recurrence.It showed significantly lower of the VAS and ODI score after surgery and at the last time of follow-up(P<0.05).There were excellent in 17 cases,good in 4 cases,and fair in 1 case according to Macnab criteria,with an excellent and good rate of 95.5%.Conclusion Single incision percutaneous transforaminal endoscopic lumbar discectomy is effective in the treatment of double segmentals of lumbar disc herniation.